Welcome to Professional and Technical Services (PTS) – experts in chemical disinfection for infection prevention. Our goal is to educate and provide you the latest resources related to cleaning and disinfection of environmental surfaces, medical devices and hands. As specialists in disinfectant chemistries, microbiology, environmental cleaning and disinfection, facility assessments and policy and procedure creation we are dedicated to helping any person or facility who uses chemical disinfectants.

Friday, January 27, 2012

As Nicole and I strive to bring our readers interesting and relevant topics relating to infection control and environmental cleaning, we are always happy to receive suggestions from you, the reader.One consistent recommendation from the readers we’ve spoken with is a comprehensive review of the most widely used disinfectant chemistries.Infection control practitioners, environmental services management, occupational health and safety professionals, directors of care or nurse managers are often saddled with the responsibility of selecting the disinfectants for their organization.Unfortunately, this decision is often made without the knowledge of what truly sets each distinct disinfectant chemistry apart from one another.Therefore, Nicole and I hope that through a monthly blog focussing on disinfectant chemistries we will be successful in imparting some basic chemistry knowledge so that when the time comes to select the disinfectant, you can confidently make an educated decision.

Before we delve into a review of our first disinfectant chemistry, we must include the caveat that our brief reviews cannot possibly encompass all of the disinfectant chemistries available on the market – of which there are over 300, or each and every iteration of that chemistry.The purpose of these postings is to provide you with the salient points as to what differentiates one disinfectant chemistry from another.More often than not, we will utilize key decision making criteria such as: speed of disinfection, spectrum of kill, cleaning or detergency capabilities, safety profile, environmental profile, cost effectiveness and ease of use as the measuring stick for each chemistry.Without further ado, let’s jump into our review of quaternary ammonium compounds, forthwith referred to simply as Quats.

Quats are ubiquitous in our modern day culture as they can be formulated to address a multitude of applications ranging from fabric softeners and anti-static agents to pharmaceutical preservatives to disinfectants.The antimicrobial capabilities of quats were first observed in the 19th century and have been used in disinfectant formulations ever since.Over the past several decades, chemical formulators have repeatedly manipulated the molecular structure and experimented with various blends of quats developing several generations of quats in the process.All in an attempt to continually improve their performance across various criteria.The exceptionally broad use of quat disinfectant products – both consumer and commercial applications included – can largely be attributed to several characteristics.Quats are widely regarded as very stable and highly dilutable making them viable, cost-effective solutions for general cleaning and disinfection.Furthermore, at the concentrations typically used for surface disinfection, quats are generally considered quite mild and innocuous requiring very few controls or precautions in their use.When used as a standalone active ingredient (no added alcohols or solvents) quats do however suffer from less than stellar germicidal performance.Generally speaking, quats are only readily effective against easier to kill microorganisms such as vegetative bacteria (Staph. aureus, Salmonella sp., etc.), enveloped viruses (Influenza A, HIV, etc.) and fungi (Aspergillis sp., etc.).However, even in the case of these relatively easy to kill pathogens quats often require a contact time upwards of 10 minutes to do so.Hardier microorganisms such as non-enveloped viruses (Norovirus, Rotavirus, Hep A, etc.), Mycobacteria (M. terrae, M. fortuitum, etc.) and Bacterial Spores (Clostridium difficile) are not effectively addressed with the use of a quat based disinfectant.This can be a major detractor for use in healthcare settings where these pathogens are commonplace.

With these key points fresh in your mind, how would you grade quats as a disinfectant chemistry?

Here’s how we would score quats on the key decision making criteria:

Speed of Disinfection – C

A 10 minute contact time is mediocre or average amongst disinfectants and ultimately unrealistic to achieve disinfection on a regular basis.

Spectrum of Kill – C

Narrow spectrum effectiveness against only bacteria, fungi and easy to kill enveloped viruses is nothing to write home about.Other disinfectants will be required to supplement the use of quats in healthcare.

Cleaning Effectiveness – B

Although quats carry some detergency capabilities, cationic surfactants are inferior to the cleaning efficiency of non-ionic and anionic surfactants found in other disinfectant formulations.

Safety Profile – B-

At their in-use concentrations, quats are generally non-toxic and non-irritating for users.However, older generations have been known to contain hormone disrupting components.Likewise, added dyes and fragrances are common which can cause sensitivities or even negatively impact indoor air quality.

Environmental Profile – C+

Quats are known to accumulate in the environment and because of their widespread use this ultimately raises aquatic toxicity concerns. Newer formulations have been formulated to achieve Eco-certifications such as Green Seal and EcoLogo.

Wednesday, January 18, 2012

Recently, I was chatting with an Environmental Services manager who works for a large hospital. He was telling me about his struggle dealing with competing challenges in his operation. On the one hand, he and his team were expected to provide cleaning services that maintained a safe and hospitable environment for the patients and staff. On the other hand, the hospital was struggling to improve access to care and was planning on accelerating patient throughput. Capping-off his trilogy of woes was the fact that the finance department was expecting him to save money and reduce the cost of his department. “Safety” he lamented, “is about consistently performing to the required standard, using well trained staff, following proper protocols and techniques, and having the resources to do the job”. “If the hospital wants to increase patient throughput, I will need more staff and equipment, yet saving money is all about cutting”. “I don’t know what they expect – I can’t work miracles” he complained. “The icing on the cake” he confided, “was something I overheard from another hospital employee”. We were in a meeting to review the findings from an outbreak investigation on one of our patient care units; someone made a remark “what’s wrong with the Housekeeping staff, why don’t they get it?” “It’s so frustrating, we get it! but our hands are tied” he exclaimed.

The manager’s story sounded familiar to me; I’ve heard it before. Having worked with Environmental Services teams in many health care facilities, I can say that this particular manager’s frustration is shared by his colleagues across the country. While everyone likes to be appreciated and recognized, Environmental Services do not need to be reminded how important the work they do is, they know it! What they need is help; to communicate the message that investment in Environmental Services is a wise decision, one that directly contributes to the strategic priorities of the healthcare organization, Wellness, Access, and Cost.

Through a clean environment, patient safety is improved. While we have always believed this to be true, a growing body of clinical research is emerging that validates what Florence Nightingale knew back in the 1800’s (and every good mother has always known),Cleaning Saves Lives!. A clean environment reduces opportunities for Hospital Acquired Infection (HAI). Infection Prevention and Control thought-leaders support this understanding and are leading a growing chorus of voices, championing the critical contribution Environmental Services makes to patient safety.

If you think about how a hospital or long term care facility operates, it is not hard to picture the vital contribution Environmental Services makes to improving patient access. Through the cleaning of vacated beds, stretchers in the emergency department, operating rooms turnovers etc., patient throughput is accelerated. Medical and clinical resources can only be effective, if “the environment is ready for care”.

From a “unit-cost” perspective, Environmental Services represents good value.If you’re like me, you spend way-too-many hours contemplating the “comparative economic value” of Environmental Services, verses other forms of investment a hospital might make, to reduce HAI rates or improve patient access.It doesn’t take an MBA, to appreciate the “Return On Investment” for increasing Environmental Services staff, supervisory and equipment resources.Spending on Environmental Services is not just common sense; it’s good business sense as well.

Some people would say that things (in healthcare) have never been worse. I say, “It’s a great time to be in the healthcare cleaning profession!” The stakes have never been higher, however senior healthcare leaders are beginning to appreciate the vital contribution Environmental Services makes to the efficient and effective operation of a healthcare facility. Our challenge (in Environmental Services leadership) is to rise to the opportunity.

Yours in Service Excellence…

Mark Heller

Mark Heller is an independent healthcare and operations executive. As Vice President – Environmental Services, for Alberta Health Services, Mark led the integration of North Americas largest Environmental Services organization; responsible for the cleaning of clinical and non-clinical environments, patient portering and waste management in health care facilities, across Alberta, Canada. As national technical leader for Aramark Health Care, Mark and his team were responsible for supporting Environmental Services operations, in healthcare facilities across Canada. Having worked with Environmental Services leaders in over 350 healthcare facilities, Mark has established a national and international profile, and is widely recognized in Infection Prevention and Control circles. Mark has been a member of CHICA Canada for many years. Presently completing a post-graduate degree in business administration (MBA) with the Queen’s School of Business, Mark consults for healthcare and business organizations in the area of healthcare support services.

Wednesday, January 11, 2012

I finally got around to watching the movie Contagion.I had expected great performances from its stellar cast, but I was enthralled by the cinematography of how they portrayed the concept of hands and surfaces playing such crucial roles in infection transmission.While I’m not certain I agree with Dr. Erin Mears’ (played by Kate Winslet) statement that the average person touches their face 2000 – 3000 times per day, I do agree that unknowingly we touch our faces a lot.I refuse to think of how many contaminated surfaces I touch during the course of any given day!

While Contagion was portraying an unknown virus (which of course makes for a better story), the movie could instead be the poster child for how Norovirus gets transmitted!And let’s face it, its winter, which is Norovirus season and from the statistics I have been seeing so far, the 2011-2012 Norovirus season is off to a banger start!The UK has confirmed that the number of cases seen across the UK is 19% higher than during the same period last year.Within the first 10 days of 2012 there are already 2 confirmed Norovirus outbreaks in 2012 aboard Cruise Ships (there was a total 10 outbreaks during 2011).The Public Health Agency of Canada says that of the provinces and territories that report data to the National Enteric Surveillance Program, all have experienced Norovirus outbreaks in long-term care and other institutions over the past few weeks with 11 outbreaks in long-term care facilities occurring within the Toronto area since Christmas.YIKES!!

So what is Norovirus?It’s a nasty little virus that causes vomiting and diarrhea, that’s what.Noroviruses are the most common cause of epidemic gastroenteritis, responsible for at least 50% of all gastroenteritis outbreaks worldwide which equates to approximately 267,000,000 annual infections worldwide, and is also a major cause of foodborne illness. Scarier yet, is the fact that according to some published studies that only 1 case of Norovirus is identified for every 1562 cases that likely exist!Norovirus spreads easily and by multiple routes. A single visitor to a hospital ward or long-term care facility might initiate an outbreak by person-to-person contact, vomiting staff members or patients can disseminate the virus by airborne means, and contaminated surfaces, such as doorknobs and computer keyboards, can sustain an epidemic. As I write this blog it is only 9:30 am and already I have dropped my son off at daycare (germ city!), driven my car to work (when was the last time I disinfected the steering wheel), have touched countless surfaces around the office and ate my breakfast at my desk…..and no I did not wash my hands before I ate.I am walking on the wild side.

The ability of Noroviruses to persist in the environment for perhaps even 3–4 weeks likely contributes to the high number of outbreaks.Further studies have demonstrated that Norovirus can be transmitted sequentially to 7 different surfaces, including door handles and telephone receivers, after volunteers touched 1 surface originally contaminated with only 30 µL (which is really, really small) of fecal fluid.I shudder to think how many times the volunteers touched their faces after their hands were contaminated with poo……

To make matters worse, Norovirus is highly resistant to many of the commonly used disinfectants used to clean environmental surfaces on a daily basis in hospitals, long-term care facilities, schools, restaurants and office buildings.There are numerous products registered by Health Canada and the US EPA that carry efficacy claims against Norovirus, but it is imperative that you verify the product’s efficacy and do not assume the disinfectant you may currently be using will be effective should Norovirus decide to rear its ugly head at your facility.Nor can we rely on alcohol-based hand sanitizers as Norovirus exhibits resistance to these too.Plain soap and water is the best method to rid our hands of this pesky virus!

Needless to say, Norovirus is not a pathogen that should be treated lightly…unless of course like me you need to shed the weight you gained over Christmas!

Friday, January 6, 2012

Happy New Year fellow clean freaks and germaphobes!I too would like to take a moment to mirror Nicole’s sentiments from our last blog, thanking each and every one of you whom have read our blog.It is a truly rewarding experience to know that the stories we share are making an impact and hopefully helping some of you in the process.For 2012 we hope to build on the momentum we’ve created in 2011 and take the Talk Clean to Me blog to be to the next level in the process.In addition to our typical weekly blogs and monthly posts by interesting and exciting guest bloggers, we intend to build a broader base of learning into the blog content for 2012.In particular, one posting a month will be dedicated to a comprehensive review of the key attributes of a specific disinfectant chemistry.I’m sure many of you are yawning at the thought of this, but trust me, we are going to try our hardest to deliver this information in a fun and interesting manner.Just think, you may have the opportunity to heckle us if our performance is subpar.Ultimately, this is all in an effort to equip each of you with a solid foundation of general knowledge pertaining to the different disinfectant actives routinely used throughout North America and around the world so that you can make a more educated decision when faced with this dilemma in the future.Starting in January, we will review the good, the bad and the ugly about quaternary ammonium compounds (Quats, QACs).We hope you will stick with us throughout 2012.Please keep your comments and suggestions coming.We are always open to more ideas.Here’s to a great year of “Talking Clean”!